Addictions change agent: A day in the life of an Advanced Practice Nurse

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When it comes to improving the lives of people recovering from addiction -- and advancing the specialty of addictions nursing -- Sara Ling wants to make a difference.

“My goal is to be a change agent,” says Sara, who became an Advanced Practice Nurse earlier this year. “There are always new things to learn and roll out at CAMH, to improve treatment for our clients.”

Sara was working as a Registered Nurse at CAMH when she went back to school to take her career a step further. She enrolled in a Master of Nursing program with a collaborative in Addiction Studies at the University of Toronto. A Barford Scholarship supported her studies there as well as her Advanced Practice Nursing internship back at CAMH.

Now working mainly with the Medical Withdrawal Services team, and with a home base in CAMH Professional Practice, she bridges front line care with building best practices in her discipline.

We met Sara to find out more about her diverse role at CAMH.

Building best practices: CAMH Advanced Practice Nurse Sara Ling.

What was the first thing on your to-do list today?

Our team always starts the day with a morning huddle. We met at 9 a.m. to talk about where clients are at in their treatment and recovery. We have 12 beds on our unit, with a mix of clients who are withdrawing from alcohol or other drugs. In some cases we are initiating opioid agonist maintenance treatment. This is a treatment for clients using illegal drugs such as heroin -- and more often now for misuse of prescription drugs such as fentanyl and hydromorphone.

Our clients are typically with us for seven to 10 days. Treatment may include medications to reduce their risk of seizure, minimize symptoms such as tremors, and reduce cravings. We also provide a range of supportive therapies and groups.

It’s a fast paced environment. For the huddle, we want to get all the interdisciplinary voices and talents in the room: physicians, residents, pharmacists, nurses, students, social workers, recreation therapists, dietitians. This ensures we’re on the same page for client care.

This morning we were looking at optimizing medication for some clients to address their withdrawal symptoms. We also discussed new clients who were admitted. We’re always looking to reduce risk – for example we have a client with mobility problems, so we are looking at ways to keep that person safe from a fall.

You are also working on best practices for addictions nursing. Can you tell us more about that?

We’ve been working on an addictions competency framework that is customized for mental health nurses. This will help both within CAMH – as part of a nurse’s professional planning and goal setting -- and as a guideline for mental health nursing more broadly.

We are building a set of 16 competencies, and refining them based on real-world experience from our nursing staff at CAMH. These include assessment, medications, screening and supportive physical care. Another key competency is understanding substance use and its interaction with mental and physical health. With physical health, for example, addictions clients often have related health problems such as liver and heart disease, and diabetes.

This initiative will also integrate CAMH expertise with literature at the national and international level.

What is your role in advancing technology for nurses?

I’m taking part in the optimization phase of I-CARE, our clinical information system. Like other clinicians at CAMH, the addictions services teams enter and view client information in the system. We are continuing to refine the system to support client care.

I’m working on a tool related to the use of one medication, called phenobarbital, in some withdrawal situations. We want this tool and information to be available on the system in future.

What are your other priorities for clients today?

Our team will get together for an Intake meeting – focusing on continuity of care. Today we’ll look at pain management for two clients who have complex pain issues. This weekly meeting also assesses our client referrals from many different sources such as the CAMH Addiction Medicine Service, other CAMH clinics and community agencies.

For cases where there are complex issues, we go over the key information before the person arrives at our program. Sometimes we need to reach out to another program at CAMH or at a community agency to clarify information.

The best reward is when I can work with the team to solve an issue. I was always drawn to the area of addiction and mental health, so this is where I want to be. I’m grateful to my nursing mentors including Margaret Gehrs (Director of Interprofessional Practice), Alison Watson (Advanced Practice Nurse) and Kirstin Bindseil (Advanced Practice Clinician).

And I’m grateful to CAMH for all of the opportunities to make a difference.